**THE HARTFORD**

**Policy Number**
10 XS FC4132

This endorsement forms a part of the policy as numbered above, issued by THE HARTFORD INSURANCE GROUP company designated therein, and takes effect as of the effective date of said policy unless another effective date is stated herein.

**Effective Date:** Effective hour is the same as stated in the Declarations of the policy.
**Endt. No.:**

**PREMIUM ENDORSEMENT**

IT IS AGREED THAT ITEM #3 OF THE DECLARATIONS "PREMIUM" IS COMPLETED TO READ AS FOLLOWS:

IF THE POLICY PERIOD IS MORE THAN ONE YEAR, THE PREMIUM IS PAYABLE:

- ON EFFECTIVE DATE OF POLICY 1-1-82 $880.00
- 1ST ANNIVERSARY 1-1-83 $880.00
- 2ND ANNIVERSARY 1-1-84 $880.00

Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated.

This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.

**Form G-2240-3 A Printed in U.S.A.**

Countersigned by: Authorized Agent

The company located these documents in its business records. At this time, the company does not certify that these documents constitute a complete and accurate copy of the policy.